How to get individual health insurance

To get individual health insurance, first decide whether you want an ACA plan or to buy directly from an insurance company.

Healthcare.gov has comparison tools, cost calculators and educational resources to help you select the right plan for you and your family. The website can also help you estimate any premium subsidies you may be eligible for. Healthcare.gov, as well as the state websites, have representatives available to help.

If you live in one of the 17 states with its own exchange, you will use the state website to enroll. Those states include:

  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Idaho
  • Kentucky
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Nevada
  • New Jersey
  • New Mexico
  • New York
  • Pennsylvania
  • Rhode Island
  • Vermont
  • Washington

For any other state, use the federal government’s Healthcare.gov health insurance exchange to enroll.

You can find more individual and family options by shopping directly through health insurance companies offering plans outside the exchanges.

How much does it cost to buy health insurance on your own?

Generally, the less you have to pay out-of-pocket for deductibles, copays and coinsurance, the more you'll pay in premiums. Platinum plans charge higher premiums than the other three plans, but have lower deductibles. Bronze, meanwhile, has the lowest premiums but the highest out-of-pocket cost.

When deciding on the level, consider the medical services you used over the past year and what you expect next year. Healthcare.gov and the individual state websites have calculators to help you.

According to the Kaiser Family Foundation (KFF), the average premiums for bronze, silver and gold plans are:

PlanAverage Cost
Bronze$329
Silver$428
Gold$462

Bronze and Silver are the most popular plans -- 32% of insureds have Silver plans, and 56%% have Bronze plans. Only 10% have Gold plans, and 1% have Platinum plans.

What’s the cheapest health insurance?

The cheapest premiums in the ACA marketplace are Bronze plans. If you are eligible for subsidies, your premium cost for Silver and Bronze plans may be similar. Healthcare.gov and state websites have calculators to help you estimate your subsidies and total cost.

Non-ACA-compliant plans may be less expensive, but the benefits are limited. Be sure to compare them to the ACA plans before deciding.

There are also very cheap plans called catastrophic plans. These have very specific eligibility requirements and low monthly costs but high deductibles.

When can you buy an individual health plan?

You can purchase or change individual health insurance during the open enrollment period. Open enrollment for most states is from Nov. 1 to Jan. 15. States with their own exchanges usually offer expanded open enrollment.

States with slightly different open enrollment periods include California, the District of Columbia, Idaho, Maryland, New Jersey, New York, and Rhode Island.

The only other time you can get individual health insurance coverage is if you have a qualifying event that launches a special enrollment period. These events may have caused you to lose your health insurance coverage. The special enrollment period lasts 60 days.

Special enrollment qualifying events include:

  • Getting married
  • Having a baby, adopting a child or placing a child for adoption or foster care
  • Moving
  • Becoming a U.S. citizen
  • Leaving incarceration
  • Losing other health coverage due in the past 60 days to job loss, divorce, COBRA expiration or aging off a parent’s plan
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
  • Change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies
  • Gaining status as a member of an Indian tribe

The ACA marketplace’s open enrollment is usually from Nov. 1 to Jan. 15 in most states, but some states have different periods.

People with income up to 150% of federal poverty level ($19,320 for a single person, $32,940 for a family of three) are eligible for a monthly special enrollment period. The Centers for Medicare and Medicaid Services estimates that about one-third of marketplace plan members qualify.

Do you need individual health insurance?

If you aren’t eligible for employer-sponsored health insurance, Medicare, Medicaid, veteran’s benefits or any other government program, you should buy individual health insurance.

You can buy individual health insurance through the ACA marketplace and non-ACA policies through brokers and directly from insurance companies.

What do individual health plans cover?

ACA marketplace Individual health insurance plans offer comprehensive coverage. ACA marketplace plans have to offer coverage regardless of your health history. You qualify for individual health insurance even if you’re pregnant or have a long-term condition like diabetes or a serious illness such as cancer. ACA marketplace health plans can’t cap the benefits you receive and limit out-of-pocket costs you must pay in a year.

In addition, all ACA marketplace individual health plans must cover a standard set of 10 essential health benefits:

  • Outpatient care, including doctor’s visits
  • Emergency room visits
  • Hospitalizations
  • Pregnancy and maternity care
  • Mental health and substance abuse treatment
  • Prescription drugs
  • Services and devices for recovery after an injury or due to a disability or chronic condition
  • Lab tests
  • Preventive services, including health screenings, immunizations, and birth control. You pay nothing out of pocket for preventive care when you see healthcare providers in your plan’s network.
  • Pediatric services, including dental and vision care for kids.

Plans that are not ACA-compliant are available directly from insurance companies. They’re generally less expensive, have limited benefits, and can decline to offer coverage based on your health history.

How to choose an individual health plan

There are different types of individual health plans. Plans in the ACA marketplace are divided into four metal tiers to make comparing them easier. The tiers are based on the percentage of medical costs the plans pay and the portion you pay out of pocket. Out-of-pocket costs include deductibles, copayments, and coinsurance.

PlanPlan PaysYou Pay
Bronze60% of healthcare costs40% of healthcare costs
Silver70% of healthcare costs30% of healthcare costs
Gold80% of healthcare costs20% of healthcare costs
Platinum90% of healthcare costs10% of healthcare costs

The percentages are estimates based on how much medical care an average person would use in a year. Platinum plans, which pay 90% of healthcare costs, are more expensive than Silver plans that pay 70% of healthcare costs. Not all providers accept every plan.

Individual health insurance subsidies

People who buy an individual health plan through the ACA exchanges may be eligible for subsidies that reduce the cost of premiums.

The ACA allows tax credits and subsidies. Only people with household income below 400% of the federal poverty level are eligible for subsidies.

The Inflation Reduction Act of 2023 expanded subsidies through 2025. When searching for a plan through the ACA exchanges, the site provides cost estimates, including subsidies.

Reminder: People with an individual health plan outside of the exchanges aren’t eligible for subsidies.

Other ways to get health insurance

Individual health insurance is an option, but there are other ways beyond an employer plan for a person to get coverage:

  • Short-term plans. These plans don’t offer the same benefits as a normal health insurance plan. Insurers aren’t required to provide comprehensive benefits. Most short-term health plans don’t cover maternity, prescription drugs and mental health. Instead, you pay for that care yourself. Short-term plans aren't meant as a long-term health insurance solution. You can only have them for one year and can request two extensions. These plans are low-cost, but they have limited benefits. Also, a handful of states don’t allow short-term plans, while others restrict them to shorter time frames.
  • Medicaid. Medicaid is available to people who qualify. Thirty-nine states expanded Medicaid, which allows people who make up to 138% of the federal poverty level eligible for Medicaid. That level is $17,609 for a single person, $23,791 for a two-person family and $36,156 for a family of four. Medicaid plan costs depend on your income, but you’ll pay less for Medicaid than an employer or individual plan if you qualify. Medicaid offers comprehensive health insurance despite the lower costs.
  • Catastrophic health plans. If you’re under 30 or meet income requirements, you could qualify for a catastrophic health plan. These plans offer lower premiums but come with much higher deductibles and out-of-pocket costs than standard health insurance plans. The idea behind catastrophic plans is to give people coverage to prevent financial ruin if they have emergency health care needs. Unlike short-term health plans, which don’t cover many services, catastrophic plans offer the same level of coverage as standard ACA plans.

What to consider when buying individual health insurance

Consider your health care needs and budget when shopping for an individual health insurance plan.

Here are some questions to consider:

How much flexibility do you want in your plan?

When choosing an individual health plan, you want to consider the type of benefit design. Health maintenance organization (HMO) plans are the most common plan design in the individual market.

HMOs include restricted provider networks. HMO members can only see doctors and get care from facilities in those networks. Also, you need a primary care provider referral to see a specialist.

Exclusive provider organization (EPO) plans don’t allow you to get care outside of the network, but you also don’t need a referral to see a specialist.

Preferred provider organization (PPO) plans are more flexible. You can see doctors both in your network and outside the network. You don’t have to get referrals to see specialists. However, PPOs have much higher premiums than HMOs, so you pay more for that flexibility.

Find out the differences between HMOs, PPOs and other types of health plans.

Are your providers in network?

Check the health plan's network to ensure it has a good selection of hospitals, doctors and specialists. Look for your providers in the plan’s network.

This is especially true if you get an HMO. HMOs have a restricted network and won’t pay for the care you receive outside of the network.

If you get a PPO, you’ll likely be able to get out-of-network care, but it can come at a higher price tag.

What does private health insurance cover?

Check to see if your prescription drugs are included in the plan's list of covered medications. Compare other benefits. Some plans may go above and beyond coverage mandated by law.

What are the insurance companies' reputations?

You’ll also want to check out the company’s consumer reviews and financial standing. You can review Insure.com’s Best Health Insurance Companies for customer satisfaction ratings and company A.M. Best Financial Strength Ratings.

Making a smart individual health insurance choice requires time and effort, but the homework you do now will pay off later when you and your family need care.

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COBRA

Consolidated Omnibus Budget Reconciliation Act
People who lose their employer-sponsored health insurance may qualify for a COBRA plan. COBRA lets you keep your former employer's health plan, but you're responsible for paying all of the costs, including your former employer's portion.
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Medicare

People who are 65 and over qualify for Medicare. You can choose Original Medicare (also called Parts A and B), which is offered by the federal government, or Medicare Advantage (also called Part C), which private insurers provide. The average annual premium for Original Medicare is about $1,600. Medicare Advantage's average yearly premium is $336, but you may have higher out-of-pocket costs than Original Medicare.
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Medicaid

Low-income Americans qualify for Medicaid. Thirty-eight states expanded Medicaid eligibility, so lower-middle-class Americans may also be eligible in those states. Medicaid offers comprehensive benefits, but at little to no cost depending on your income. Each state has its own eligibility. Some states are flexible with Medicaid eligibility for people who are pregnant, a parent or disabled. If your household income is below 138% of the federal poverty level, you're likely eligible for Medicaid if you live in a Medicaid expansion state. That level is $17,609 for an individual, $23,791 for a family of two, $29,974 for a family of three and $36,156 for a family of four. Non-Medicare expansion states have stricter income guidelines. Check with your state's Medicaid program to see if you qualify.
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Parent's employer-based health insurance

The Affordable Care Act lets children stay on a parent's health plan until the age of 26. Having a child on a parent's health plan may or may not increase premiums. It depends on whether you already have family coverage when adding the child to the plan. If a parent already has family coverage, adding a child won't likely increase premiums. However, going from single or couple to family coverage could cause premiums to skyrocket. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447.
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Spouse's employer-based health insurance

Most employers allow employees to add spouses to their health insurance. Going from single health coverage to a family plan may triple or quadruple your premiums. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447. Not all jobs allow for spouse's coverage, so you'll want to check with your employer to make sure it's an option.
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Employer-based health insurance

Most people with private health insurance get their coverage through a job. employer-sponsored health insurance is usually cheaper than individual health insurance unless you qualify for Affordable Care Act subsidies. Job-based plans are generally less expensive because businesses often pick up more than half of employer-sponsored health insurance premiums. Kaiser Family Foundation estimates the average premiums for a single coverage employer-sponsored health plan is $1,186 and the average family plan is $5,447 annually.
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Employer plans are often one of these types of four plans. Click on each one to find out more.
  • PPO
  • HMO
  • HDHP
  • EPO

Preferred-provider Organization (PPOs)

  • Pay higher premiums with a lower deductible
  • You have access to more providers, but pay much more for health insurance
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You want the ability to get out-of-network care
Preferred-provider organization (PPOs) plans are the most common type of employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but those added costs offer you flexibility. A PPO allows you to get care anywhere and without primary care provider referrals. You may have to pay more to get out-of-network care, but a PPO will pick up a portion of the costs.
Find out more about the differences between plans

Health maintenance organization (HMO)

  • Pay higher premiums with a lower deductible
  • Restricted network of providers with lower premiums
  • You want to choose a primary care physician
  • You don't mind getting a referral
  • You don't care about the ability to get out-of-network care
Health maintenance organization (HMO) plans have lower premiums than PPOs. However, HMOs have more restrictions. HMOs don't allow you to get care outside of your provider network. If you get out-of-network care, you'll likely have to pay for all of it. HMOs also require you to get primary care provider referrals to see specialists.
Find out more about the differences between plans

High-deductible health plans (HDHPs)

  • Pay lower premiums with a higher deductible
High-deductible health plans (HDHPs) have become more common as employers look to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but much higher deductibles. A deductible is what you have to pay for health care services before your health plan chips in money. Once you reach your deductible, the health plan pays a portion and you pay your share, which is called coinsurance.
Find out more about the differences between plans

Exclusive provider organization (EPO)

  • Restricted network of providers with lower premiums
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You don't care about the ability to get out-of-network care
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with the restricted network found in an HMO. EPOs don't require that members get a referral to see a specialist. In that way, it's similar to a PPO. However, an EPO requires in-network care, which is like an HMO.
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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
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To find the kind of ACA plan for you, would you rather...
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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
People who would prefer to pay lower premiums with a higher deductible may want the below plans
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Silver is the second most popular plan in the ACA exchanges, with 35% of people with a Silver plan. Silver has lower premiums than any plan except for Bronze. However, it has lower out-of-pocket costs than Bronze. Silver plans pick up 70% of the costs, while members pay 30% The average single coverage in a Silver plan is $481 monthly and $1,179 for a family plan.

Bronze is the most popular type of plan in the ACA exchanges, with 41% of members with a Bronze plan. These plans have the lowest premiums, but also the highest out-of-pocket costs in the exchanges. Bronze plans pick up 60% of the costs, while members pay 40%. The average single coverage monthly cost in a Bronze plan is $440 and $1,080 for a family plan.

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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
People who would prefer to pay higher premiums with a lower deductible may want the below plans
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Platinum plans have the highest premiums but the lowest out-of-pocket costs. So, you pay more for the coverage initially but less than other plans when you need health care services. Platinum plans pick up 90% of the costs, while members pay 10%, Not many health insurers offer Platinum plans. Only 2% of members in ACA plans have a Platinum plan, so you may have trouble finding one. The average monthly premiums for single coverage in a Platinum plan is $706 and the average family coverage costs $1,460.

Gold plans have lower premiums than Platinum, but higher premiums than Silver and Bronze. Gold also has lower out-of-pocket costs than Silver and Bronze, but higher than Platinum. Gold plans pick up 80% of the costs, while members pay 20%. The average monthly premium for a single Gold plan is $596. Family coverage averages $1,426 per month.

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-- Les Masterson contributed to this report.

Sources:

Health insurance FAQs

Can I buy health insurance on my own?

Yes, individual health insurance plans are available for people who don't have a health insurance plan through their employer. If they qualify for individual health insurance coverage, they can buy it on the open marketplace. Be sure to know your income limits and other requirements before you apply.

You may also be able to find an individual or family policy from another source such as an insurer that offers individual policies. Ensure you understand the terms before signing up for anything.

Can you get private health insurance?

If you do not have an employer-sponsored plan and are not eligible for Medicare or Medicaid, you can purchase insurance policies directly from private companies or through the health insurance marketplace.

What two parties pay for your health insurance if you enroll in an employer-sponsored plan?

Employers are responsible for buying individual health insurance for their employees. They do the research, choose an insurer and determine your plan options. Both parties share the costs of these plans, you contribute to your monthly premiums, the amount is deducted from your monthly paycheck, and your employer also pays a portion of the premium.

Can you buy health insurance for someone else?

You can buy health insurance for minor children or include them in your plan. You can pay premiums for anyone you like, but they must apply for the coverage.

How do you pay for health insurance on your own?

Marketplace subsidies can make health insurance premiums affordable for many people. If you aren’t eligible for subsidies, a high-deductible plan may be an option. You can contribute to a health savings account (HSA) if you have a high deductible plan and use pre-tax money to pay for qualified medical expenses, including deductibles.

Is it cheaper to buy your own health insurance?

If you’re eligible for an employer-sponsored plan, you’re generally not eligible for ACA subsidies. A short-term plan may be less expensive; however, the benefits will be much more limited than your employer’s plan.